1992978654 NPI number — MRS. GLORIA S ESCOBAR MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992978654 NPI number — MRS. GLORIA S ESCOBAR MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ESCOBAR
Provider First Name:
GLORIA
Provider Middle Name:
S
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992978654
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/28/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
148 ISLIP AVENUE
Provider Second Line Business Mailing Address:
SUITE 27
Provider Business Mailing Address City Name:
ISLIP
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11751
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-650-6580
Provider Business Mailing Address Fax Number:
631-650-6578

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
148 ISLIP AVENUE
Provider Second Line Business Practice Location Address:
SUITE 27
Provider Business Practice Location Address City Name:
ISLIP
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11751
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-650-6580
Provider Business Practice Location Address Fax Number:
631-650-6578
Provider Enumeration Date:
04/02/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  249522 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Q00000X , with the licence number: 249544 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 297185702 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 754858P . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 8865361001 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 8891P2 . This is a "EMPIRE BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P4028576 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 8515062 . This is a "MULTIPLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 03113155 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1238845 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 9524277 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".